To preliminarily analyze the application value of ultrasonography on postoperative monitoring of simultaneous pancreas-kidney transplantation (SPK).

The ultrasonographic data of 5 cases undergoing SPK in the Affiliated Hospital of Qingdao University from August 2019 to November 2019 were retrospectively analyzed. Five donors underwent conventional two-dimensional ultrasound examination before transplantation to assess the size and internal echo of the kidney and pancreas. Kidney transplantation and pancreas transplantation were performed in turn. Ultrasound examination was performed once a day within 1 week after transplantation, once every 3 days after 1 week, and once every 2 months after 1 month, or according to the condition. The peak systolic velocity (PSV) and resistance index (RI) of the transplanted pancreas and kidney before and after transplantation and at the 1st, 3rd, 7th and 1st month after transplantation were compared using the repeated measure of ANOVA, Least-Significance Difference was used for pairwise comparison. A P<0.05 was considered statistically significant.

Conventional two-dimensional ultrasound showed that within 1 week after the operation, the transplanted pancreas was plump, with low parenchymal echo, homogeneous and no dilatation of the pancreatic duct; and the transplanted kidney is plump in shape, with uniform cortical echo, clear boundary of cortex and medulla, and no separation of collection system. The anteroposterior diameter of transplant pancreas head, body, tail, and the long diameter, anteroposterior diameter and left and right diameter of transplant kidney were all longer than before the transplantation (all P<0.05). The anteroposterior diameter of transplant pancreas head, body, tail and the length of transplant kidney 1 month after transplantation were all smaller than that of the first day (all P<0.05). Color doppler flow imaging (CDFI) showed that the vascular display of all branches in pancreas was good in 5 cases within 1 week after transplantation, the PSV of the internal pancreatic artery is 16.6-37.2 cm/s, and the RI is 0.52-0.70, the portal-vena cava in 4 cases showed well and the frequency spectrum was characterized by two-way or three-way wave. The postoperative portal-vena cava anastomosis showed poor clarity in 1 case, contrast-enhanced ultrasonography was performed: the blood flow of superior mesenteric artery, splenic artery, arteriloes of transplant pancreas showed well in the arterial-phase, and portal-vena cava and splenic vein were shown in the venous-phase. No perfusion disorders was found in pancreatic parenchyma. Five cases of transplanted kidney showed clear three-level blood flow, the PSV of the renal artery was 24.2-123.0 cm/s, RI was 0.55-0.81. There were no statistically significant differences in PSV and RI between the head and tail arteries of transplant pancreas, interlobar, segmental and hilar arteries of transplant kidney of the 5 recipients at the 1st, 3rd, 7th and 1st month after transplantation (F=2.823 and 0.881, all P>0.05). One Uyghur male recipient was suspected of acute rejection on the 22nd day after transplantation, and returned to normal after being treated with methylprednisolone. Up to February 2020, all 5 recipients have recovered well after the transplantation, the transplanted kidney and pancreas function well, and the renal function and blood glucose levels have returned to normal.

Ultrasonography can serve as the preferred imaging examination for dynamic monitoring after SPK. It can help to evaluate the size, volume internal echo and the blood flow of the grafts. This is of great value for early detection of postoperative complications.